SAJDVD: VOLUME 15, ISSUE 1, JULY
2018
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- From the Editor’s Desk
Authors: Mahomed, FA
From: South African Journal of Diabetes and Vascular Disease, Vol 15, Issue 1, July 2018
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- Profile, bacteriology and antibiotic
susceptibility pattern of diabetic foot ulcers
at the Federal Medical Centre, Makurdi, Nigeria
Authors: JE Ojobi , P Mbaave baave , A Ubumneme , M Abonyi
From: South African Journal of Diabetes and Vascular Disease, Vol 15, Issue 1, July 2018
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Objectives: The projected increase in the prevalence of diabetes mellitus (DM) is expected to be accompanied by a corresponding increase in associated complications. Foot problems are an increasingly important public health complication of DM. A major obstacle in the management of foot ulcers in diabetes is the colonisation of wounds by virulent pathogens, causing increasing rates of morbidity and mortality. In this article, we present a review of the profile, bacteriology and antibiotic susceptibility pattern of foot ulcers in individuals living with type 2 diabetes mellitus (T2DM), hospitalised at the Federal Medical Centre (FMC), to aid planning of services and provide a sensible approach to empirical antibiotic therapy while awaiting culture and sensitivity reports.
Methods: This was a hospital-based, retrospective, descriptive study that reviewed the profile, bacteriology and antibiotic susceptibility pattern of foot ulcers in individuals living with T2DM who were admitted for foot ulcer(s) over a three-year period (2012–2014) at the FMC. Approval for the study was obtained from the ethics committee of the institution. Relevant data (gender, age, residence, occupation, DM duration, ulcer duration, glycosylated haemoglobin status) were extracted from the files.
Results: One hundred and nine T2DM case files, made up of 44 females and 65 males (1:1.5) with a mean age of 53.5 ± 11.4 years, were extracted. They were mostly farmers in their fifties with poor glycaemic control who had had T2DM for more than a decade and foot ulcers for more than six months. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. There was a high level of sensitivity to quinolones and resistance to penicillins.
Conclusion: Late presentation, poor glycaemic control, high rate of wound infection with S aureus, resistance to penicillins and sensitivity to quinolones were noted.
- Cardiovascular disease risk assessment in Nigerian adults with type
2 diabetes or the metabolic syndrome, using the Framingham risk score
Authors: Ifeoma Christiana Uden ze, Casmir Ezenwa enwa Amadi
From: South African Journal of Diabetes and Vascular Disease, Vol 15, Issue 1, July 2018
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Background: Cardiovascular morbidity is a major burden in Nigerian patients with type 2 diabetes mellitus (DM). Predicting and quantifying cardiovascular risk could help in more focused and aggressive management of type 2 DM and its cardiovascular complications.
Aim: The aim of this study was to compare the cardiovascular risk scores of type 2 diabetes subjects on treatment with those of individuals with the metabolic syndrome, and healthy controls, and to examine the impact of glycaemic control and lifestyle on cardiovascular risk in adult Nigerians
Methods: This was a cross-sectional study of 40 adult men and women with type 2 diabetes attending the Diabetic Clinic, 40 adult men and women with the metabolic syndrome, and 40 age- and gender-matched males and females, who were recruited as healthy controls. The metabolic syndrome was defined based on the NCEP-ATP III criteria. Socio-demographic and clinical data were collected using a structured questionnaire. Venous blood was collected after an overnight fast.
Results: There was a statistically significant difference in the cardiovascular risk scores between the group with diabetes (20.41 ± 12.98), the group with the metabolic syndrome (10.00 ± 6.35), and the control group (6.79 ± 7.81) (p < 0.001). There was also a statistically significant difference in the glycated haemoglobin (HbA1c), high-density lipoprotein cholesterol, total cholesterol and triglyceride concentrations between the three study groups (p < 0.05). Cardiovascular risk correlated positively and significantly with HbA1c level, body mass index and waist circumference, and negatively with education level (p < 0.05). Only 52.2% of the diabetics on treatment achieved an HbA1c target of < 7%.
Conclusion: Type 2 diabetes patients on treatment had high cardiovascular risk scores, and control of cardiovascular risk factors was not optimal in adult Nigerians, especially in individuals with type 2 diabetes or the metabolic syndrome. Strategies to achieve better glycaemic control, weight reduction and increased literacy levels would help achieve cardiovascular risk reduction in adult Nigerians.
- Prevalence, awareness, treatment and control of hypertension,
diabetes and hypercholesterolaemia among adults in Dande municipality, Angola
Authors: João M Pedro, Miguel Brito, Henrique Barros
From: South African Journal of Diabetes and Vascular Disease, Vol 15, Issue 1, July 2018
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Objectives: To estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterol- aemia in an Angolan population aged 15 to 64 years and to determine relationships with sociodemographic, behavioural and anthropometric characteristics.
Methods: A total of 2 354 individuals were assessed for behav- ioural, sociodemographic and physical characteristics in a cross-sectional, community-based survey. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios for each variable related to the condi- tions were calculated using logistic regression models.
Results: Overall, the prevalence of hypertension was 18.0%, diabetes 9.2% and hypercholesterolaemia 4.0%. Among hypertensive individuals, the awareness rate was 48.5%; 15.8% were on treatment and 9.1% had their blood pressure controlled. Only 10.8% were aware they had diabetes, 4.5% were on treatment and 2.7% were controlled. The awareness level for hypercholesterolaemia was 4.2%, with 1.4% individuals on treatment and 1.4% controlled.
Conclusions: The prevalence levels of hypertension and diabetes, which were higher than previous findings for the region, together with the observed low rates of awareness, treatment and control of all conditions studied, constitute an additional challenge to the regional health structures, which must rapidly adapt to the epidemiological shift occurring in this population.
- Assessment of left atrial function in patients with type 2 diabetes
mellitus with a disease duration of six months
Authors: Oyku Gulme z, Hulya ulya ulya Parildar , Ozlem Cigerli , Nilgun Demira ğ
From: South African Journal of Diabetes and Vascular Disease, Vol 15, Issue 1, July 2018
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Introduction: Changes in left atrial (LA) size and function are associated with adverse clinical events. Recently, duration of diabetes mellitus (DM2) has been found to be positively associated with increased LA volume and impaired LA function. This study was performed, using two-dimensional echocardiograpy, to evaluate the changes in LA volume and function in patients with DM2 with a disease duration of six months, and to assess the parameters that affect LA volume and function.
Methods: Fifty-six patients (28 male, age: 52.6 ± 6.5 years) with DM2 and 56 controls (24 male; age: 50.1 ± 7.0 years) were enrolled in the study. Each subject underwent conventional two-dimensional echocardiography to assess LA volume (indexed maximal LA volume: Vmax, pre-atrial contraction volume: Volp, minimal LA volume: Vmin) and LA function [passive emptying volume – passive emptying fraction (PEV – PEF), active emptying volume – active emptying fraction (AEV – AEF), total emptying volume – total emptying fraction (TEV – TEF)].
Results: LA diameter, indexed Vmax, Volp, Vmin, AEV and TEV were found to be significantly higher in the DM2 group compared with the controls (p < 0.05). Indexed Vmax, Volp and Vmin were significantly correlated with HbA1c level, body mass index (BMI), high-sensitivity C-reactive protein and uric acid levels, mitral A wave, E/E’ ratio and A’ wave. According to multivariate analysis, age and BMI had a statistically significant effect on LA volume.
Conclusion: Impaired LA function may be present in patients with newly diagnosed DM2. BMI and increasing age caused LA enlargement and LA volumes that were independent of the effects of hypertension and DM2.
- Cerebrovascular disease in Sudan: a huge gap to be bridged
Authors: Muwada uwada Bashir Awad wad Bashir , Samuel Nambile Cumber
From: South African Journal of Diabetes and Vascular Disease, Vol 15, Issue 1, July 2018
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Abstract: Organised national structural and research efforts are crucial to minimising the high morbidity and mortality burdens attributed to cerebrovascular disease in Sudan. The dearth of quality research evidence to guide decision making in neurological services, and the lack of political will and resources have accounted for the uncertainty regarding this major health problem in Sudan. This article reviews the research efforts on cerebrovascular diseases in Sudan from an epidemiological and health-service point of view, highlighting areas of information deficiency and recommending health-system and research-based interventions to improve cerebrovascular disease status in Sudan.
- Risk factors for diabetic foot ulceration
Authors: Simiao Ntuli, Craig Vincent Lambert, André Swart
From: South African Journal of Diabetes and Vascular Disease, Vol 15, Issue 1, July 2018
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Objective: The main purpose of the study was to investigate the need for podiatrists as members of the primary healthcare team. One of the objectives of the study was to determine the percentage of patients presenting at the two primary healthcare clinics who are at risk of developing foot complications as a result of an underlying concomitant systemic disease.
Methods: This was a descriptive, cross-sectional study in which data were collected from patients presenting at two homogeneously selected primary healthcare clinics in Johannesburg. Nursing staff assisted by a final-year podiatry student collected data using a self-constructed data-collection form from each consenting patient as part of their routine patient consultation. Simple descriptive statistics were used for data analysis.
Results: Data were collected and analysed from 1 077 patients and showed that 29% of the patients had diabetes. Diabetic foot ulceration risk factors that were recorded included peripheral neuropathy in 74% of the diabetic patients, structural foot deformities in 47%, peripheral vascular symptoms in 39% and foot ulcer in 28% of the diabetic patients.
Conclusion: Early identification of diabetic patients who are at high risk of diabetic foot ulceration is important and can be achieved via mandatory diabetic foot screening with subsequent multi-disciplinary foot-care interventions. Understanding the factors that place patients with diabetes at high risk of ulceration, together with an appreciation of the links between different aspects of the disease process and foot function, is essential for the prevention and management of diabetic foot complications.
- 2017 SEMDSA diabetes management guidelines
Authors: David Webb
From: South African Journal of Diabetes and Vascular Disease, Vol 15, Issue 1, July 2018
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Abstract: The updated 2017 South African guidelines for the management of type 2 diabetes mellitus were launched on 5 May at the 52nd congress of the Society of Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) in Johannesburg. This is the fourth edition of the guidelines, which were last updated in 2012. The 2017 edition has been completely revised and updated using the most recent clinical science, with contributions from more than 45 local experts in various aspects of diabetes management. It is a comprehensive document, consisting of 29 chapters covering epidemiology; definitions; diagnosis; screening and organisation; lifestyle interventions; glucose management; co-morbidities and complications (weight management, cardiovascular risk, hypertension, diabetic kidney disease, diabetic eye disease and diabetic foot); along with type 2 diabetes management in special patient populations (pregnant women, children and adolescents, the elderly, those with HIV, those observing Ramadan, drivers and men with sexual dysfunction).
The guideline has been written with the clinician in mind and is practical and easy to use. Recommendations are summarised in table form at the beginning of each chapter and information relating to support for the recommendations is included in appendices at the end of the document.
The following is a brief summary of general recom-mendations and highlights information that is new or where recommendations from past editions of the guideline have been updated.
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RELIABLE EXPERT INFORMATION
The SAJDVD’s main focus is
providing new and relevant information for doctors,
nurses and allied professionals involved in caring
for the diabetes patient.
But as we are part of the larger Diabetes team, we would like to reach out to all patients with relevant information. So here it is!
But as we are part of the larger Diabetes team, we would like to reach out to all patients with relevant information. So here it is!
